Vincent DeGennaro: Don’t blame physicians

Published: Thursday, February 7, 2013 at 6:01 a.m.

Last Modified: Wednesday, February 6, 2013 at 4:35 p.m.

A Feb. 1 article in the New York Times focuses on a report that erroneously blames physicians for driving up health-care costs by charging patients exorbitant fees for out-of-network services. But this so-called report from America’s Health Insurance Plans (AHIP) is less an analysis than a sensationalist hatchet job based on misleading statistics and incomplete information.

First, it intentionally focuses on extreme examples and chooses headline-grabbing figures that do not reflect typical out-of-network charges. By cherry-picking the highest charges they could possibly find, AHIP is attempting to paint physicians as greedy while drawing attention away from criticism that the insurance industry provides inadequate coverage, wrongfully denies claims and overpays its executives.

There’s an important distinction here: Charges and payments are not the same, and AHIP didn’t bother to investigate how much the physicians in the cases that it cited were actually paid. Physicians want their patients to get the care that they need and will often work with them to negotiate out-of-network fees and insurers. In fact, insurers have often been accused of underpaying doctors for out-of-network services. For example, in 2009,

UnitedHealth Group agreed to pay $350 million to settle allegations that it was underpaying physicians for out-of-network services through the use of a flawed database.

Further, AHIP’s comparison of out-of-network charges to Medicare rates is intentionally deceptive as private insurers typically pay providers at negotiated rates that are much higher than what Medicare offers. Instead, AHIP could have compared median out-of-network charges to what’s typically paid for the same service on an in-network basis in the same geographical location. Instead of unfairly painting physicians as the villains in this scenario, the insurance industry would do well to address its role in driving up the cost of health care: Floridians saw their individual insurance premiums spike 45 percent and family premiums rise 58 percent between 2003 and 2011.

The bottom line is that AHIP’s report does nothing to address the real cost drivers in health care and serves only to antagonize physicians who are simply trying to do the right thing for their patients. This badly flawed “analysis” amounts to little more than a campaign of misinformation.

Dr. Vincent DeGennaro is president of the Florida Medical Association.

<p>A Feb. 1 article in the New York Times focuses on a report that erroneously blames physicians for driving up health-care costs by charging patients exorbitant fees for out-of-network services. But this so-called report from America's Health Insurance Plans (AHIP) is less an analysis than a sensationalist hatchet job based on misleading statistics and incomplete information. </p><p>First, it intentionally focuses on extreme examples and chooses headline-grabbing figures that do not reflect typical out-of-network charges. By cherry-picking the highest charges they could possibly find, AHIP is attempting to paint physicians as greedy while drawing attention away from criticism that the insurance industry provides inadequate coverage, wrongfully denies claims and overpays its executives.</p><p>There's an important distinction here: Charges and payments are not the same, and AHIP didn't bother to investigate how much the physicians in the cases that it cited were actually paid. Physicians want their patients to get the care that they need and will often work with them to negotiate out-of-network fees and insurers. In fact, insurers have often been accused of underpaying doctors for out-of-network services. For example, in 2009,</p><p>UnitedHealth Group agreed to pay $350 million to settle allegations that it was underpaying physicians for out-of-network services through the use of a flawed database.</p><p>Further, AHIP's comparison of out-of-network charges to Medicare rates is intentionally deceptive as private insurers typically pay providers at negotiated rates that are much higher than what Medicare offers. Instead, AHIP could have compared median out-of-network charges to what's typically paid for the same service on an in-network basis in the same geographical location. Instead of unfairly painting physicians as the villains in this scenario, the insurance industry would do well to address its role in driving up the cost of health care: Floridians saw their individual insurance premiums spike 45 percent and family premiums rise 58 percent between 2003 and 2011.</p><p>The bottom line is that AHIP's report does nothing to address the real cost drivers in health care and serves only to antagonize physicians who are simply trying to do the right thing for their patients. This badly flawed “analysis” amounts to little more than a campaign of misinformation. </p><p><i>Dr. Vincent DeGennaro is president of the Florida Medical Association.</i></p>